Some test taking techniques:

A-ssimilate essential principles in the care of patients in the community

These principles may include:
1. have a purpose or objective when conducting home visit
2. plan ahead
3. priority should be given to the recognized needs of the family
4. there is no definite rule as to the frequency of a home visit
5. frequency of home visit should take into account, the physical, psychological and educational needs of
the individual and family
6. the initial step in conducting a home visit is to GREET the client and introduce yourself
7. soiled articles with discharge should be boiled in water 30 minutes before laundering

B- ag Technique
- steps which are carried out by the nurse to facilitate the performance of nursing procedures with ease and
deafness
Remember the:
Bag and its contents must be protected from any possible contamination
Always wash your hands to prevent the spread of infection
Gather all necessary articles and supplies to answer emergency needs
Note: blood pressure apparatus and stethoscope are carried separately

Consider the following principles:

1. prevention of contamination
Note: place waste paper bag outside the work areas
2. protection of the caregiver
Note: clean and alcoholize all articles after use
3. make articles readily accessible
Note: place the articles in one corner of the work area
4. make follow-up care
Note: set the date and time for the next visit

C- ommunity Based Rehabilitation Program

• the goal of this program is the improvement of quality of life and productivity of disabled persons
• R.A 7277, Magna Carta for Disabled Persons, serves as the legal basis of the program
• The components of the program include: social preparations, services preparation, training, information,
education and communication and monitoring, supervision and evaluation
• The VISION of the Department of Health is: health for all Filipinos
• The MISSION of the Department of Health is: Ensure accessibility of health care to improve the
quality of life of all Filipinos especially the poor
• The basic principles to achieve improvement in health include:
E – nsure universal access to basic health services
E – pidemiological shift from infectious to degenerative disease must be managed
E – nhance the performance of health sector
E – nsure the priotization of health and nutrition of vulnerable groups
• The primary strategies to achieve health goals include:
S – upport for frontline health workers and to local system development
A – ssurance of health care
I – ncreasing investment for primary health care
D – evelopment of national standard and objectives for health
• Primary health Care (PHC), according to the World Health organization is an essential health care
made universally accessible to individuals and families in the community by means acceptable to them
through their full participation and at a cost that the community and country can afford at every stage
of development
• The goal of PHC is health for all Filipinos and Health in the hands of the people by the year 2020
• Letter of instruction (LOI) 949 (October 19, 1979) is the legal basis of PHC
• The first international conference on primary health care was held in Alma, Ata, USSR on September 6-
12, 1978 sponsored by the WHO and UNICEF
• The framework for meeting the goal of primary health care is organizational strategy, it calls for among
communities, private and government agencies with the end view of health development
• The four cornerstone/pillars in primary health care includes:
1. active community participation
 2. intra and inter sectoral linkages
3. use of appropriate technology
4. support mechanism made available
• The expanded program on immunization aims to reduce the morbidity and mortality among infants
and children caused by the six childhood immunizable diseases. It was launched in July 1976.
P.D. 996 (September 16, 1976) provides for compulsory basic immunization for infants and
children below 8 years of age. The EPI program is based on epidemiological situations.
Presidential proclamation no. 147 (March 3, 1993) declares April 21 and May 19, 1993 and
every third Wednesday of January and February thereafter for two years as National Immunization Days.
R.A. 7846 (December 30, 1994) requires compulsory immunization against hepatitis B for infants
and children below 8 years old
• the ultimate goal of promotion of reproductive health is “QUALITY OF LIFE”. The focus of the
Philippine framework of the program is Reproductive Health status in terms of, its elements. The ten
elements of Reproductive Health includes:
1. maternal and child health and nutrition
2. family planning
3. prevention and management of abortion complications
4. prevention and treatment of reproductive tract infection (RTI’s) including STD’s, HIV and
AIDS
5. education and counseling on sexuality and sexual health
6. breast and reproductive tract cancers and other gynecological conditions
7. men’s reproductive health
8. violence against women
9. prevention and treatment of infertility and sexual disorders
10. adolescent reproductive
• the goal of the 2000 Nutritional Guidance for Filipinos is the improvement of nutritional status,
productivity and quality of life of the population through adoption of desirable dietary practices and
healthy lifestyle. An example is the exclusive breastfeeding of infants from birth to 4-6 months and
the use of iodized salt.
• The use of fluoride in the prevention of tooth decay is carried out by making four application of
fluoride about a week apart among children who are aged 3, 7, 10 and 13 because at these ages
new teeth have erupted
• The goal for health care and services for older persons is to provide a longer disability-free life. This
is carried out through a holistic care approach
• To reduce the blindness prevalence rate in the Philippines, the prevention of blindness program was
conceived. It is subdivided into four programs namely, cataract program, primary eye care, vitamin A
deficiency program and other eye care program
• The goals of the mental health program include: promotion of mental health, decreased health-
related effects of stressful lifestyle and reduction of prevalence of mental ill health and disorders
in the Philippines
• The Sentrong sigla movement aims to promote availability of quality health services in health centers
and hospitals and to make these services accessible to every Filipino
• “Sang Milyong Sepilyo” is a strategy for social mobilization of Dental health program. It aims to
emphasize the importance of oral health in relation to total body health to increase public awareness on
the prevention of common dental diseases

D- OH PROGRAMS

D- ental health Program

O- steoporosis prevention
H- ealth education and Community Organization

P- rimary Health Care

R- eproductive health
O- lder Persons health Services
G- uidelines for Good Nutrition
R- espiratory Infection control
A- ccupressures
M- aternal and Child care
S- entrong Sigla Movement

E- pidemiology

• Systematic and scientific study of the distribution patterns and determinants of health, disease and
condition for the purpose of promoting wellness and preventing disease conditions
 • Basic concepts that guide epidemiological study include: biostatistics, aggregate at risk, the natural
life history of a disease, levels of prevention, host-agent-environment relationships, multiple
causation, person-place-time-relationships
• When monitoring incidence of infectious disease, the term used to distinguish relative frequency
in time and space include the following:
Sporadic – presence of occasional cases of the disease
Endemic – constant long-term presence of the disease
Epidemic – presence of the disease at a much higher frequency over a short period of time
Pandemic – presence of a disease in many countries in a relatively short period of time
• Effective implementation of the epidemiological process requires a multi disciplinary approach
• A community health nurse must apply the principles of epidemiology in order to provide
preventive services to the community
• Community health nurses participate in may epidemiological activities like: case finding, health
teaching, counseling and follow up essential to the prevention of diseases and other conditions

F- ormulas for Mortality and Morbidity Statistics

CRUDE BIRTH RATE (CBR) – a measure of one characteristics of the natural growth or increase of a
population

CBR= total number of live births registered in a given calendar year x 1000
Estimated population as July 1 of same year

CRUDE DEATH RATE (CDR) – a measure of one mortality from all causes which may result in a
decrease of population

CDR= total number of deaths registered in a given calendar year x 1000

Estimated population as of July 1 of same year

INFANT MORTALITY RATE (IMR) –measure the risk of dying during the 1st year if life

IMR= total number of deaths under 1 year of age registered

in a given calendar year x 1000
total number of registered live births of same calendar year

MATERNAL MORTALITY RATE (MMR) – it measures the risk of dying from causes related to
pregnancy, childbirth and puerperum

MMR= total number of deaths from maternal causes registered

For a given year x 1000
total number of live births registered of same year

INCIDENCE RATE (IR) –measures the frequency of occurrence of the phenomenon during a given
period of time. Deals only with new cases

IR= no of new cases of a particular disease registered

During a specified period of time x 100, 000
Estimated population as of July of same year

PREVALENCE RATE (PR) –measures the proportion of the population which exhibits a particular
disease at a particular time. Deals with total (old and new) number cases

PR= no of new and old cases of a certain disease registered

At a given time x 100
Total no of persons examined at same year given time

K- ey Points to EPI

• A fully immunized child should have received one (1) dose of BCG, three (3) doses of DPT, three
(3) doses of OP, three (3) doses of hepatitis B and one (1) dose of measles, before the child’s
birthday
 • Moderate fever, malnutrition, mild respiratory infection, cough, diarrhea and vomiting are not
contraindications to vaccination
• DPT2 or DPT3 is not given to a child who has had convulsion or shock within 3 days of the
pervious dose
• BCG vaccine is not given to a child with clinical AIDS
• Measles and polio vaccines are most sensitive to heat

ADMNISTRATION OF VACCINES
Vaccine Dose Route of Site of administration
Administration

BCG Infant- Intradermal Right deltoid region of

the arm

School age entrance- Intradermal Left deltoid region of

the arm
DPT, HEPATITIS B 0.5 ML Intramuscular Upper, outer portion of
the thigh
POLIO 2 drops, or depending on Oral Mouth
manufacturer’s
instructions
MEASLES 0.5 ml Subcutaneous Outer Part of the Upper
arm
TETANUS TOXOID 0.5 ml Deep Intramuscular Deltoid region of the
upper arm

K- ey Points in Vaccine Administration

• BCG- lay the syringe and needle almost flat along the child’s arm
- if the vaccine is injected correctly into the skin, a flat wheal with the surface pitted like an
orange peer will appear at the injection site

• OPV – if necessary open the child’s mouth by squeezing the cheeks gently between your fingers
to make lips point upwards
- put drops of vaccine straight from the dropper onto the child’s tongue but do not let the
dropper touch the child’s tongue
- if the child spit out the vaccine, give another dose

• HEPA and DPT – the best injection site is the outer part of the child’s midthigh
- ask the mother of the child to hold the child’s legs

• MEASLES –the best injection site is on the outer side of the upper arm

• TETANUS TOXOID –the best injection site for a woman is the outer side of the left upper arm

Vaccine Dose Timing of Vaccination

TT1 5-6 months of pregnancy
TT2 1 month/ 4 weeks after TT1
TT3 at least 6 months later
TT4 at least 1 year later
TT5 at least 1 year later

Note: TT1 gives initial protection, TT2 provides 3 years protection for the mother, TT3 provides 5
years protection, TT4 provides 10 years protection and TT5 provides lifetime protection of the mother

M- edicinal Plants

Herbal Plant Use/s

Akapulko Anti-fungal

Ampalaya Diabetes Mellitus

Bawang Hypertension (to lower cholesterol levels in the blood)

 Toothache
Remember:
BawHaT (Bawang for Hypertension, toothache)

Bayabas/ Guavas Diarrhea

Washing of wounds
Gargle to relieve toothache

Lagundi S-kin diseases

H-eadache
A-sthma, cough and fever
R-heumatism, sprain, insect bites
E-czema
Dysentery

Niyug-niyogan Anti helminthic

Sambong Anti-edema
Diuretic
Anti-urolithiasis

Tsaang Gubat Remember:

Stomach ache
Tsaang gubat
Diarrhea

Yerba Buena S-wollen gums

P-ain
I-nsect bites
T-oothache
M-enstrual and gas pain
A-rthritis
N-ausea and fainting
D-iarrhea

Ulasimang bato Uric acid excretion

(pansit pansitan) Remember:
Ulasimang bato, uric acid

REVIEW BULLETS FOR CHN

• Acupressure
- traditional Chinese medicine believes that life is the result of QI or life energy
- when there is an imbalance of YIN and YANG forces, there is illness
- YIN is the yielding negative and feminine force: YIN principle: give Chinese cold deserts after
surgery
- Yang is the dominating, positive and masculine force
- posture: lying down or sitting up
-foods to avoid; iced food/drinks, sour food, alcohol drink, pepper and spices, seafood, peanuts,
salty foods
- TSUN measurement- method of locating points in the body using the patient’s own hands or
fingers as a base for measurement
- contraindications: pregnancy, full stomach and cardiac illness

• Acupuncture
- stimulating specific anatomic points called HSUEH
- goal: manipulation of energy flow throughout the body following as thorough assessment by a
practitioner
- indication: acute and chronic pain and motion disabilities
- contraindications: pregnancy, hemophlia, acute CVD

• Aromatherapy
- based on olfactory stimuli used to help balance the DOSHAS, the mediators between physiologic
and psychologic process
- done often at night to induce sleep
- use of essential oils of plants to treat symptoms

• Bag Technique
- a tool making use of the public health bag through which the nurse during the visit can perform
nursing procedures with ease and deftness, saving time and effort at the end in view of rendering
effective nursing care
- PUBLIC HEALTH BAG –essential and indispensable equipment of the public health nurse
- principles: should minimize if not totally prevent the spread of infection: should save time and effort
- special consideration: hand washing
- content of the bag: Bp apparatus and stethoscope are carried separately; medicines also include –
betadine, 70% alcohol, benedict’s solution
- place waste paper bag outside of work area to prevent contamination of clean area

Sample Questions:
1. this is the tool trough which the nurse, during home visit can perform nursing procedures with ease
and deftness, saving time and effort with the end of view of rendering effective nursing care:
a. public health bag
b. bag technique
c. home visit
d. all of the above
2 the public health bag contains basic medications and articles which are necessary for giving care
during home visits. Its contents are he following EXCEPT:
a. soap, adhesive plaster and tape measure
b. betadine, acetic acid and benedict’s solution
c. surgical scissors and forceps
d. stethoscope and sphygmomanometer

CARE OF THE OLDER PERSON

- first cause of morbidity among the 50+ years old: influenza
- top cause of mortality among the 60+ years old: Diseases of the heart
- common health problems: difficulty in walking, difficulty in chewing, impaired vision in at least one
eye, hearing problem
- goal: “A longer disability free life’
- Resolution 46: the UN principle for older persons to add life to years that have been added to life

COMMUNITY HEALTH NURSING:

- Goal: promotion of the client’s optimum level of functioning through teaching and delivery of
care
- Philosophy: based on the worth and dignity of man
- the primary focus of CHN practice is HEALTH PROMOTION
- community health nurse are generalists in terms of their practice
- family is the unit of service
- HEALTH TEACHING is the primary responsibility of the community health nurse

Sample Question:
1. the key role for the community health nurse in dealing with communities is to:
a. make sure that people in the community are empowered and able to participate
b. provide incentives for community members to follow the protocols of any study or drug trial
c. establish project teams that will collect and analyze data
d. closely direct community members so that the community assessments are done appropriately

CHN ROLES OF THE NURSE:

- Clinician: focus on the health of individuals in the larger context of the community
- Advocate: advocates self-care, people’s ability to be active participants in their own health, and self-
determination, the right to make their own decisions
- Collaborator: brings together strengths and resources of people involved toward a common goal
- Counselor; key tasks include listening and providing feedback and information
- Educator: provides skills, knowledge and attitudes that the people need to make appropriate choices
or decisions
_ Hospice care: providing care skills in a home or other setting and balancing the client’s needs

Sample questions:
1. the community health nurse acting in the role of clinician would be more likely to:
a. work to participate the special needs of a population such as homeless people
b. focus on reducing the incidence of disease in a population
c. address the spiritual needs of a group without performing any screening or treatment
d. coordinate the various components of care to different areas of thr health system
2. the CHN acting in the role of advocate would be most likely to promote;
a. self-care and self-determination for the population
b. telling the people in a community that the medical experts know what is best for them
c. smoking cessation
d. that health care options should be pursued without the influence of friends or families
3. which of the following is not a role for the community health nurse providing hospice or end of life
care?
a. providing resources for caregivers to prevent burnout
b. ensuring that the client is given every reasonable chance to extend life and is encouraged not to give
up too easily
c. working as part of a multidisciplinary team to meet client’s, family and community needs
d. promoting and coordinating palliative care and services

COMMUNITY ASSESSMENT:
- process of examining the community in collaboration with the community members to develop
strategies that improve health and quality of life for the community
- community competence refers to the community’s ability to identify needs, achieve working
consequence and agree and work together to meet goals
- three dimensions include: status, structure and process
- status- information about morbidity and mortality, life expectancy, crime rates and education
- structure – socioeconomic, age, gender, resources
- process – how the community operates and functions as a whole

Sample questions:
1. a community is best described as:
a. people living in the same place
b. organizations, family groups and friend groups that interact
c. groups that have common interest or needs
d. all of the above
2. a community that is described as having community competence has which of the following
characteristics?
a. the ability to perform their own cross-sectional epidemiological studies
b. the ability to delegate any community processes to an outside expert such as community health
nurse
c. the ability to identify their own needs, achieve consensus, plan and implement goals
d. the ability to predict morbidity and mortality rates for the population
3. all of the following are part of the community assessment process, EXCEPT:
a. identifying available resources such as time, money and team skills
b. collecting and analyzing information
c. withholding results from the community until they can be statistically confirmed, to avoid alarming
people
d. setting action priorities based on the needs of the community and available resources
4. a valid way to collect data for a community assessment is:
a. using a library database for literative review
b. reading government documents to find out about previous data
c. using surveys or questionnaires to gather information from the community members
d. all of the above

CHN CLINIC VISIT:

- PRE-CONSUATION VISIT: clinical history taking, vital sings, physical assessments, laboratory
exams and documentation
- MEDICAL EXAMINATION: ensure privacy, safety and comfort of the patient throughout procedure
- POST-CONSULATION: explain findings and needed care, refer as needed, make appointment for
nest clinic/ home visit

Sample questions:
1. during clinic visits, all of the following are done in the consultation conference, EXCEPT:
a. take clinical history after greeting and making client at ease
b. refer client to other related staff or agency if necessary
c. take temperature, BP, height and weight
d. perform physical assessment and selective laboratory examination

COMMUNITY ORGANIZING:
- a continuous of awareness building, organizing and mobilizing community members towards
community development
- phases of activities:
PRE-ENTRY- preparation of the staff
- site selection
ENTRY PHASE – integration with the community
 - courtesy calls, information campaigns, identification of potential leaders
CORE-GROUP FORMATION AND MOBILIZING
- integration with the core group
ORGANIZATIO- BUILDING
- organizing barrio health committee, setting up the community organization
CONSOLIDATION AND EXPANSION PHASE
- networking and establishing linkages, implementation of livelihood-projects and
developing secondary leaders

Sample questions;
1. one of the primary tasks of the community health nurses during the pre-entry phase is the selection
of the barangay to become the initial site for their organizing efforts. The following are the steps in the
selection of the project site by the team, EXCEPT:
a. developing criteria for site selection
b. identifying potential barangays and choosing the final project village
c. identification of potential leaders
d. identification of the host family
2. it is during this period that one member of the team formed was given the ole of a community
organizer:
a. organizing-building phase
b. core stoup formation phase
c. consolidation phase
d. expansion phase
3. for potential leaders to perform their roles effectively, they have to possess certain characteristics.
Among these are the following, EXCEPT:
a. they must belong to the poor sector
b. they must be respected members of the community
c. preferably informal leaders
d. formal leaders with many community responsibilities
4. this phase signals the start of community self-management of any development program:
a. consolidation and expansion phase
b. core group formation
c. entry phase
d. organization building phase
5. under this phase of the education and training process, the conduct of training, monitoring and
documentation of training are included in:
a. implementation phase
b. planning phase
c. evaluation phase
d. post-training phase

DENTAL HEALTH PROGRAM:

- vision: a lifetime oral health and no tooth decay for the nest generations
-objective: to prevent and control dental diseases and conditions
- “Sang milyong Sepilyo”- project for social mobilization of dental health program

DEPARTMENT OF HEALTH:
- Vision: health for all filipinos
- mission: enhance accessibility and quality of health care to improve the quality of life of all Filipinos,
especially the poor
- basic principles to achieve improvement of health
1. ensured universal access to basic health services
2. health and nutrition of vulnerable groups must be prioritized
3. epidemiological shift from infection to degenerative diseases must be managed
4. performance of the health sector must be enhanced
- primary strategies:
1. assurance of health care
2. increased investment for primary health care
3. development of national standards and objectives for health
4. support to local health system development and frontline health workers
Sample questions:
Situation: the department of health formulated plan, programs and projects with the vision, “health for all Filpinos’
1. which of the following is the mission of the department of health?
a. promote healthy lifestyle
b. ensure accessibility and quality of health care
c. reduce morbidity and mortality
d. improve general health status of the people
2. which of the following is not a basic principle in the achievement of improved health?
a. health and nutrition priorities
b. universal access to health service
c. enhancement of performance of health sector
d. investment for primary health care
3. which of the following is not a primary strategies to achieve health goals?
a. support of local health system
b. development of national standards for health
c. assurance of health care for all
d. funding from non-government organization